| Objective: In clinical , defects of ulna and radium is common, which can be caused by all kinds of factors such as severe trauma, osteotomy of nonunion sclerosis, osteomyelitis, bone tumors excision and so on. The fracture of ulna and radium has a high incidence rate, which is about 11.2% of systemic fractures, and the incidence of the fracture delayed unions or not is as much as 20% after operation, therefore bone defects caused by osteotomy of nonunion sclerosis have the highest proportion. The length and position change of ulna and radium can not only effect the rotation function of the forearm, but also cause the forearm flexing and extensor muscle tension imbalances after the bone defects, which can affect function of wrist and hand .At the same time, the factors, for example severe trauma, several operations and infection, induce to the defect of skin and scar formation in the fracture position. The bone defect was treated by abdominal skin flap and free bone auto-graft before and needed several operations to accomplish. This method had a long treatment cycle and fracture healing time. After the operation, the skin flap looked fat and clumsy and the implanted free bone was absorbed, which could easily caused operation failure. Especially the defects of long segment ulna and radium were difficult to repair by traditional treatment and the function of affected limb poor recovered in late stage. Meanwhile, the defects of ulna and radium always combined with the damage of ulnar artery and radial artery, which could induce to the hand's blood supply shortage and affect the hand's feeling and motor function. This kind of complex trauma could get timely and accurate treatment or not directly related to the future recovery of forearm function. Using the traditional method to repair the bone defects had a long treatment cycle and fracture healing time , which was not benefit for early functional exercise that caused the forearm and hand functional recovery poor . Therefore looking for a short cycle and effective methods to repair this kind of complex trauma in the orthopaedic clinic has always been a worthful topic to deeply discuss. Based on this, from January 2008 to December 2010, 7 cases with the combined defects of ulna ,radium and skin were successful reconstructed with string-type fibular flap.Methods: 7 cases with the combined defects of ulna, radium and skin were reconstructed by string-type fibular flap. Blood circulation design: Vascular pedicle length, vascular kiss contacts and corresponding style were designed according to the results of forearm and crus angiography. Skin flap design: The perforating branches skin flap with fibular artery was designed according to the position, shape and size of the skin defect. Preoperative design of bone length: We compared radiographs of the injured forearm with the uninjured side, and measured the distance between the bilateral olecroanon to the styloid process of ulna and the distance between the capitulum radius to the malleolus radialis to make sure the practical length of the bong defects, and then we decided the corresponding method of the fibular section according to the location and length of bone defects. It needs fine procedure in operation and guides patients the scientific and systemic rehabilitation training after operation. Follow-up ranged from 12 months to 18 months, it need to shot x-ray, appraise and record the fracture clinical healing time at every month in the one year after the operation. The forearm rotation Angle is evaluated at 12 months after operation. At the same time, comprehensively evaluate the recovery of the injured limb through limb pain, functional movement, self-perception, degree of appearance satisfaction, fine procedure, and working capability according Enneking scoring system.Result: 1 patients appeared venous crisis 13 hours following the operation, gave Exploration of blood vessel and dislodged thrombus by emergency operation, then venous crisis was relieved. Follow-up ranged from 13 to 18 months, the average time was 15 months. Transplanted fibula and recipient site reached the fracture clinical healing standards at 3 to 5 months (average 4.2 months) after the operation. 12 months following the surgery, the forearm rotation angle score were excellent in 4 cases, good in 2 cases, and poor in 1 case. The eligible rate was 85.7%. Meanwhile the Enneking score were 26 to 30 in 2cases, 21 to 25 3 cases, and 16 to 20 in 2 cases, which indicated an average of 79.5% recovery of limb function.Conclusion: The string type fibular flap can reconstruct the combined defects of ulna, radium and skin at one time. This kind of surgery can shorten the treatment cycle obviously. The bone grafts with blood supply can shorten the fracture healing time. The short time of the treatment cycle and the fracture clinical healing time is benefit for early functional exercise,which has a good recovery of the injured limb. There are so many advantages to cure the combined defects of ulna, radium and skin with the string type fibular flap. Therefore this method has a high value of clinical application. |
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